Endoscopic mucosal resection of colorectal polyps in typical UK hospitals

Lim, Teegan Reina

doi:10.3748/wjg.v16.i42.5324

Cited by 23 publications

(20 citation statements)

References 18 publications

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“…Most series have reported a higher recurrence rate associated with piecemeal resection as compared to en bloc resection (11,31,33) . Although our findings are consistent with most previous studies, Lim et al (30) found no difference between the two techniques.…”

Section: Discussionsupporting

confidence: 93%

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Santos¹,

Malaman²,

Pereira-Lima

2011

Arq. Gastroenterol.

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-Context -Endoscopic mucosal resection is a minimally invasive technique used in the treatment of colorectal neoplasms, including early carcinomas of different size and morphology. Objectives -To evaluate procedure safety, efficacy, outcomes, and recurrence rate in endoscopic mucosal resection of colorectal lesions. Methods -A total of 172 lesions in 156 patients were analyzed between May 2003 and May 2009. All lesions showed pit pattern suggestive of neoplasia (Kudo types III-V) at high-magnification chromocolonoscopy with indigo carmine. The lesions were evaluated for macroscopic classification, size, location, and histopathology. Lesions 20 mm or smaller were resected en bloc and lesions larger than 20 mm were removed using the piecemeal technique.Complications and recurrence were analyzed. Patients were followed up for 18 months. Results -There were 83 (48.2%) superficial lesions, 57 (33.1%) depressed lesions, 44 (25.6%) laterally spreading tumors, and 45 (26.2%) protruding lesions. Mean lesion size was 11.5 mm ± 9.6 mm (2 mm-60 mm). Patients' mean age was 61.6 ± 12.5 years (34-93 years). Regarding lesion site, 24 (14.0%) lesions were located in the rectum, 68 (39.5%) in the left colon, and 80 (46.5%) in the right colon (transverse, ascending, and cecum). There were 167 (97.1%) neoplasms: 142 (82.5%) adenomatous lesions, 24 (14.0%) intramucosal carcinomas, and 1 (0.6%) invasive carcinoma. En bloc resection was performed in 158 (91.9%) cases and piecemeal resection in 14 (8.1%). Bleeding occurred in 5 (2.9%) cases. Recurrence was observed in 4.1% (5/122) of cases and was associated with lesions larger than 20 mm (P<0.01), piecemeal resection (P<0.01), advanced neoplasm (P = 0.01), and carcinoma compared to adenoma (P = 0.04). Conclusions -Endoscopic mucosal resection of colorectal lesions is a safe and effective procedure, with low complication and local recurrence rates. Recurrence is associated with lesions larger than 20 mm and carcinomas.

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Section: Discussionsupporting

confidence: 93%

Endoscopic mucosal resection in colorectal lesion: a safe and effective procedure even in lesions larger than 2 cm and in carcinomas

Santos¹,

Malaman²,

Pereira-Lima

2011

Arq. Gastroenterol.

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“…[1][2][3][4] The polyps are snared or removed with diathermy, either en bloc or in a piecemeal fashion.…”

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confidence: 99%

“…Complications of EMR are less frequent than for standard endoscopic polypectomy. [1][2][3][4][5] The most common adverse event is bleeding (which can be immediate or delayed) and significant bleeding occurs in up to 6.1% of patients. 1 Perforation is uncommon, occurring in 4% of patients, and is suspected in patients complaining of severe abdominal pain not relieved by passing flatus.…”

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confidence: 99%

“…1 Perforation is uncommon, occurring in 4% of patients, and is suspected in patients complaining of severe abdominal pain not relieved by passing flatus. 2 The risks of these complications are thought to increase with the size of polyp being excised. [1][2][3] An unusual complication of endoscopic polypectomy is post-polypectomy electrocoagulation syndrome.…”

mentioning

confidence: 99%

“…2 The risks of these complications are thought to increase with the size of polyp being excised. [1][2][3] An unusual complication of endoscopic polypectomy is post-polypectomy electrocoagulation syndrome. 1 Patients present at 12-120 hours after endoscopy with pain, fever, leucocytosis and peritoneal inflammation in the absence of frank perforation.…”

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confidence: 99%

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Subacute reaction to endoscopic mucosal resection mimicking perforation

Williamson

Dunkley

Hewin

2012

annals

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A 25-year-old woman underwent routine day-case endoscopic mucosal resection (EMR) of two ascending colonic polyps. Six hours later she re-presented with severe abdominal pain. On examination she was tachycardic with tenderness and peritonism in the right lower quadrant. Urgent abdominal computed tomography (CT) did not reveal any signs of free intra-abdominal gas or fluid but did detect transmural thickening and oedema in the ascending colon and caecum. As there was no radiological evidence of perforation, the patient was managed conservatively and made a full recovery.The exact aetiology of this patient's symptoms is not known. She may have developed post-polypectomy electrocoagulation (a transmural diathermy injury), localised ischaemia of the colonic wall (secondary to the adrenaline used during EMR) or an allergic reaction to the dye used during EMR.As EMR is an increasingly used treatment modality in the management of colonic polyps, clinicians should have an awareness of the complications of treatment. We would advocate a low threshold for prompt CT investigation in any patient presenting with abdominal pain after EMR to detect any evidence of free intraperitoneal air. Patients without signs of perforation may be managed conservatively, as in this case.

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